Revision implant augments, systems, and methods

ABSTRACT

A revision implant component comprising a body having a plurality of screw holes and a tapered head configured to engage a talar dome component of a multi-component ankle prosthesis. A surgical method is disclosed which includes creating an incision in a patient, exposing a multi-component ankle prosthesis implanted in a patient, disassembling at least one component of the multi-component ankle prosthesis, affixing a revision implant component to non-damaged bone using screws, and coupling the revision implant component to a talar dome of the multi-component ankle prosthesis.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a Divisional Application of U.S. patent application Ser. No. 14/403,829 filed Nov. 25, 2014, which is a national phase entry under 35 U.S.C. 371 of international patent application No. PCT/US2014/052301, filed Aug. 22, 2014, the entirety of which is incorporated herein by reference.

FIELD OF DISCLOSURE

The disclosed augments, systems, and methods relate to orthopedic implants. More particularly, the disclosed augments, systems, and methods relate to augment inserts for orthopedic implant revisions.

BACKGROUND

Total joint replacements are orthopedic implants for repairing or replacing a natural joint. Examples of common joints that are replaced by a total joint replacement include, but are not limited to, hips, ankles, and shoulders. The ultimate goal with any total joint sreplacement is to approximate the function and structure of the natural, healthy structures that the implant or prosthesis is replacing.

In many instances, bone adjacent to an implant suffers from bone loss, for example from osteolysis, over a prolonged period of time following a total joint replacement. In some cases, plastic or metal wear particles from operation of the prosthesis trigger an autoimmune reaction which leads to bone resorption. As bone structure is resorbed bone voids are formed which can loosen the fixation of the prosthesis within the patient, causing greater problems for the patient.

SUMMARY

In some embodiments, a revision implant component comprises a body including an inner side and an outer side, tapered such that the width of a front side is greater than the width of a back side, the body defining a plurality of screw holes and having a tapered head configured to engage a talar dome component of a multi-component ankle prosthesis.

In some embodiments, a surgical method includes creating an incision in a patient, exposing a multi-component ankle prosthesis implanted in a patient, disassembling at least one component of the multi-component ankle prosthesis, affixing a revision implant component to non-damaged bone using screws, and coupling the revision implant component to a talar dome of the multi-component ankle prosthesis. The revision implant component has a body including a head configured to engage a feature of a component of the multi-component ankle prosthesis for coupling the revision implant component to the component of the multi-component ankle prosthesis.

In some embodiments, a surgical method includes creating an incision in a patient, exposing a multi-component ankle prosthesis implanted in a patient, disassembling at least one component of the multi-component ankle prosthesis, resecting damaged bone adjacent to the at least one disassembled component of the multi-component ankle prosthesis, selecting a revision implant component from a kit containing a plurality of a revision implant components based on the desired thickness of the selected a revision implant component as a function of the depth of bone resected, affixing the revision implant component to non-damaged bone using screws, and coupling the revision implant component to a talar dome of the multi-component ankle prosthesis. The revision implant component has a body including a tapered head configured to operatively connect with a talar dome of the multi-component ankle prosthesis.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a profile view of the top of one example of a revision implant component in accordance with some embodiments.

FIG. 1B is a profile view of the top of one example of a revision implant component in accordance with some embodiments.

FIG. 2A is a profile view of the top of one example of a revision implant component in accordance with some embodiments.

FIG. 2B is a profile view of the top of one example of a revision implant component in accordance with some embodiments.

FIG. 3A is an isometric view of one example of a revision implant component in accordance with some embodiments.

FIG. 3B is an isometric view of one example of a revision implant component in accordance with some embodiments.

FIG. 4A is a schematic diagram of the placement of a revision implant component in accordance with some embodiments.

FIG. 4B is a schematic diagram of the placement of a revision implant component in accordance with some embodiments.

FIG. 5 is a flow diagram of a method in accordance with some embodiments.

DETAILED DESCRIPTION

This description of the exemplary embodiments is intended to be read in connection with the accompanying drawings, which are to be considered part of the entire written description. The drawing figures are not necessarily to scale and certain features may be shown exaggerated in scale or in somewhat schematic form in the interest of clarity and conciseness. In the description, relative terms such as “horizontal,” “vertical,” “up,” “down,” “top” and “bottom” as well as derivatives thereof (e.g., “horizontally,” “downwardly,” “upwardly,” etc.) should be construed to refer to the orientation as then described or as shown in the drawing figure under discussion. These relative terms are for convenience of description and normally are not intended to require a particular orientation. Terms including “inwardly” versus “outwardly,” “longitudinal” versus “lateral” and the like are to be interpreted relative to one another or relative to an axis of elongation, or an axis or center of rotation, as appropriate. Terms concerning attachments, coupling and the like, such as “connected” and “interconnected,” refer to a relationship wherein structures are secured or attached to one another either directly or indirectly through intervening structures, as well as both movable or rigid attachments or relationships, unless expressly described otherwise. When only a single machine is illustrated, the term “machine” shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein. The term “operatively connected” is such an attachment, coupling or connection that allows the pertinent structures to operate as intended by virtue of that relationship. In the claims, means-plus-function clauses, if used, are intended to cover the structures described, suggested, or rendered obvious by the written description or drawings for performing the recited function, including not only structural equivalents but also equivalent structures.

The disclosed systems and methods advantageously enable revisions of total ankle implants by providing augments designed to be coupled to an original or replacement implant to fill in any gaps formed in the bone. The disclosed systems and methods advantageously provide an effective coupling between the augment and an implant component such as a talar dome, as well as between the augment and bone unaffected by bone loss.

FIG. 1A illustrates one example of a revision implant component 100A in accordance with some embodiments. FIG. 1A is a profile view of the top of revision implant component 100A. Revision implant component 100A is configured for use with the left ankle joint of a patient.

Revision implant component 100A comprises a body 101 having an inner side 115, outer side 113, front side 103, and back side 111. The body 101 defines a plurality of screw apertures 107 and a pair of wire apertures 105. Body 101 further includes a head 109 which protrudes from upper surface 119.

In some embodiments, the shape of body 101 is configured to match the shape of a talar dome implant. In other embodiments, the shape of body 101 is configured to match the shape of the talus, or to match talar bone unaffected by bone loss. Thus, in some embodiments, such as that illustrated in FIG. 1A, body 101 includes a front side 103 having a bulbous shape and a back side 111 having a sulcus shape or groove 121. In some embodiments, back side 111 has a straight, curved, or bulbous edge shape. Similarly, in some embodiments front side 103 has a straight, curved, or grooved shape so as to match the shape of a talar dome implant or the talus.

Inner side 115 and outer side 113 are tapered from front to back, such that the body 101 is wider near the front side 103 than the back side 111. The taper of inner side 115 and outer side 113 is configured to fill the bone voids and rest on the remaining talar bone.

In some embodiments, screw apertures 107 are threaded. In some embodiments, screw apertures 107 include polyaxial locking tabs. In some embodiments, screw apertures 107 are configured to be used with locking screws having threaded heads.

In some embodiments, body 101 defines at least one wire aperture 105. Wire apertures 105 assist in the proper placement of revision implant component 100A during surgery. Wire apertures 105 can be configured to receive k-wires or similar surgical tools to ensure revision implant component 100A is disposed in the proper location as determined by a surgeon and as guided by surgical instrumentation.

Head 109 is configured as an interference connection to a talar dome. A tapered recess in a talar dome receives the tapered head 109, and an impact connection is made between the talar dome and head 109. In some embodiments, the head 109 is a Morse taper. In some embodiments, head 109 additionally defines a recess 117.

In still further embodiments, head 109 comprises “timed threads” that are configured such that when the threaded head 109 and threaded talar dome are properly connected, a longitudinal passageway is in alignment. Traditional threaded connections accept varying amounts of torque and respond with varying alignments; timed threads ensure a proper connection and a specific alignment so long as applied torque is within a predetermined range.

In some embodiments, the thickness of revision implant component 100A, as measured from upper surface 109 to a substantially parallel back surface (not shown in FIG. 1A, see thickness T in FIG. 4B), is configured to fit the thickness of bone lost. In other embodiments, the thickness of revision implant component 100A is configured to fit the thickness required for proper support of a talar dome implant. In other embodiments, the thickness could be angled or tapered along the length of the implant.

FIG. 1B illustrates a second example of a revision implant component 100B in accordance with some embodiments. Revision implant component 100B is a mirror image of revision implant component 100A, and is therefore configured for use with the right ankle joint of a patient.

FIG. 2A illustrates another example of a revision implant component 200A in accordance with some embodiments. FIG. 2A is a profile view of the top of revision implant component 200A. Revision implant component 200A is configured for use with the left ankle joint of a patient.

Revision implant component 200A is substantially the same as revision implant component 100A described above. However, revision implant component 200A includes a curved back side 201 in place of the groove 121 in back side 111. Additionally, head 109 defines a notch 203. In some embodiments, notch 203 has a diameter that is sized and configured to receive a screw driver or other elongate tool therein. In some embodiments, a screw driver or other elongate tool is used to assist a surgeon in removing the revision implant component 200A.

FIG. 2B illustrates a second example of a revision implant component 200B in accordance with some embodiments. Revision implant component 200B is a mirror image of revision implant component 200A, and is therefore configured for use with the right ankle joint of a patient.

FIG. 3A illustrates yet another example of a revision implant component 300A in accordance with some embodiments. FIG. 3A is an isometric view of revision implant component 300A. Revision implant component 300A is configured for use with the left ankle joint of a patient.

Revision implant component 300A is substantially the same as revision implant component 100A described above. However, revision implant component 300A includes an alternate configuration of the plurality of screw apertures 307. In this embodiment, screw apertures 307 lack the polyaxial locking tabs illustrated in FIGS. 1A and 1B. Instead, screw apertures 307 are threaded or include a deformable region adjacent to the aperture designed to contact the threaded head of a locking screw.

FIG. 3B illustrates a second example of a revision implant component 300B in accordance with some embodiments. Revision implant component 300B is a mirror image of revision implant component 300A, and is therefore configured for use with the right ankle joint of a patient.

FIGS. 4A and 4B are schematic diagrams of the placement of a revision implant component 100A in accordance with some embodiments. During surgery, portions of the talus 405 which were damaged may be resected to form a substantially planar surface 409 of bone which was not damaged (i.e. a surface of healthy or solid bone mass). Revision implant component 100A is affixed to surface 409 using a plurality of screws (not pictured) disposed through screw apertures 107. As illustrated, in some embodiments screw holes 407 are drilled into the talus prior to placement of the revision implant component 100A. In some embodiments, revision implant component 100A is affixed to talus 405 using locking screws with threaded heads. In other embodiments, revision implant component 100A is affixed to talus 405 using non-locking screws, which may provide a compressive force to revision implant component 100A against the talus 405.

Once revision implant component 100A is affixed to talus 405, a talar dome 401 is operably connected to revision implant component 100A. As discussed above, head 109 of revision implant component 100A is tapered to form an interference connection with a recess 411 defined by talar dome 401. In some embodiments, head 109 is a Morse taper. During surgery, the talar dome 401 to revision implant component 100A connection is made in situ. The talar dome 401 is placed on revision implant component 100A with recess 411 aligned with head 409. Talar dome 401 is then impacted to operably connect or bond talar dome 401 with revision implant component 100A.

FIG. 4B is substantially the same as FIG. 4A and shows a placement of a revision implant component 100A. However, in FIG. 4B, screw holes 407 are drilled at a sufficient angle and depth to reach the calcaneus bone 403. In some embodiments, the talus 405 is sufficiently damaged that it is desirable to affix revision implant component 100A through the talus 405 and to the calcaneus 403. In some embodiments, screw holes 407 are drilled at a sufficient angle and depth to reach the navicular bone (not shown)

In some embodiments, a plurality of revision implant components, such as those described above with reference to FIGS. 1A, 1B, 2A, 2B, 3A, and 3B, are provided in a surgical kit. Each of the provided revision implant components may have a varying shape or thickness (as measured from the upper surface to a substantially parallel back surface—see thickness T in FIG. 4B). By providing varying shapes, thicknesses, and angles, the kit allows a surgeon to conduct an intraoperative determination of the best-fitting revision implant component.

A method 500 for implementing a revision implant component is provided in the flow diagram of FIG. 5. The method 500 starts at block 501 and proceeds to block 503, where an incision is made in a patient. At block 505, a multi-component implant which was previously installed in the patient is exposed through the incision.

At block 507, a first component of the multi-component implant is disassembled and removed from the patient, and at block 509 damaged bone is resected in the area adjacent to the prior location of the removed first component. During a revision operation, a multi-component prosthesis that was previously implant in a patient may be partially or completely disassembled. For example, if the multi-component prosthesis is a talar prosthesis, then the talar dome can be decoupled from talar stem by disengaging the Morse taper coupling. When completely disassembled, the entire multi-component prosthesis is removed from the patient.

A revision implant component is affixed to non-damaged bone at block 511. In some embodiments, the revision implant component is affixed to non-damaged bone using locking screws or screws with threaded heads. In other embodiments, the revision implant component is affixed to non-damaged bone using non-locking screws or screws without threaded heads. In other embodiments, the revision implant component is affixed to non-damaged bone using a combination of locking and non-locking screws.

At block 513 a talar dome is placed on the revision implant component and at block 515 the talar dome is operably connected to the revision implant component. In some embodiments, the talar dome is impacted to operably connect the talar dome to the revision implant component. In some embodiments, the connection between talar dome and revision implant component is made in situ following affixation of the revision implant component to non-damaged bone. In other embodiments, the head of a revision implant component and the recess of a talar dome are threaded, and are operably connected in situ. Method 500 ends at block 517.

As described above, the revision implant components/augments can have a variety of shapes and geometries. In some embodiments, the revision implant components/augments are formed from a plasma sprayed titanium, although other materials including, but not limited to, BIOFOAM®, available from Wright Medical Technology, Inc., and other metal, ceramic, plastic, and bone growth materials.

The size and shape of the revision implant component/augment can be selected after pre-operative assessment using fluoroscopy to identify the position of a multi-component prosthesis that is implanted in bone, or the selection of the appropriate revision implant component/augment can be performed intraoperatively by a surgeon or other healthcare provider after reviewing the implant site. In some embodiments, the revision implant components/augments are individually sterilized and packaged while in some embodiments the implant components/augments are provided in a kit. For example, when provided in a kit, each individual implant component/augment may be individually packaged and included in a larger container or packaging. However, kits can also be formed without packing multiple implant components/augments in a single package.

As described above, the revision implant components/augments can have different shapes from each other and/or from the shapes of the components of the multi-component prosthesis such that the revision implant components/augments can be coupled together to fill a void in a bone. Additionally, a single revision implant component/augment can include multiple attachment means such as, for example, a taper, threads, a bayonet coupling, to list but only a few possibilities.

Although the devices, kits, systems, and methods have been described in terms of exemplary embodiments, they are not limited thereto. Rather, the appended claims should be construed broadly, to include other variants and embodiments of the devices, kits, systems, and methods, which may be made by those skilled in the art without departing from the scope and range of equivalents of the devices, kits, systems, and methods. 

1-12. (canceled)
 13. A revision implant component, comprising: a narrowing body dimensioned to substantially align with a top surface of a resected talus and a talar dome component, the body including an inner side and an outer side and defining at least one screw hole with a plurality of polyaxial locking tabs disposed about the circumference of the at least one screw hole, and a head configured to engage the talar dome component.
 14. The revision implant component of claim 13, wherein the narrowing body is substantially aligns with a bottom surface of the talar dome component.
 15. The revision implant component of claim 14, wherein the head comprises a Morse taper.
 16. The revision implant component of claim 15, wherein the head defines a recess and a notch.
 17. The revision implant component of claim 16, wherein the body further defines at least one wire hole.
 18. A surgical method, comprising: creating an incision in a patient; exposing an ankle prosthesis implanted in a patient; disassembling at least one component of the ankle prosthesis; affixing a revision implant component to non-damaged bone using screws; and coupling the revision implant component to a talar dome of the ankle prosthesis, wherein the revision implant component has a narrowing body dimensioned to substantially align with a top surface of a resected talus, the narrowing body including an inner side and an outer side and defining at least one screw hole with at least one polyaxial locking tab disposed about the circumference of the at least one screw hole, and a head configured to engage a talar dome component of an ankle prosthesis.
 19. The surgical method of claim 18, further comprising resecting damaged bone prior to the step of affixing a revision implant component to non-damaged bone using screws.
 20. The surgical method of claim 19, wherein the revision implant component is affixed to non-damaged bone using screws with threaded heads.
 21. The surgical method of claim 20, wherein the at least one screw is affixed to the revision implant component and non-damaged bone of the talus.
 22. The surgical method of claim 21, wherein the at least one screw is affixed to the revision implant component and non-damaged bone of at least one of a calcaneus bone or a navicular bone.
 23. The surgical method of claim 22, wherein the step of coupling the revision implant component to a talar dome further comprises attaching an augment between the revision implant component and the talar dome.
 24. The surgical method of claim 19, wherein the step of affixing the revision implant component to non-damaged bone further comprises attaching an augment between the revision implant component and the non-damaged bone.
 25. The surgical method of claim 19, wherein the revision implant component is coupled to the component of the multi-component ankle prosthesis in situ.
 26. A device, comprising: a body extending between a first surface configured to engage a tray implant and a second surface configured to engage an offset impactor, wherein the second surface (i) defines a first groove and a second groove extending from the second surface into the body each being sized and configured to engage the offset impactor and (ii) is configured to engage an impactor arm of the offset impactor, wherein an impaction force applied to the offset impactor is transferred to the tray implant; and a locking element configured to couple the tibial tray to body.
 27. The device of claim 26, wherein the first groove corresponds to a first size of the tray implant and the second groove corresponds to a second size of the tray implant.
 28. The device of claim 27, wherein the locking element comprises a guide body defining a channel sized and configured to receive the spring-loaded locking element therethrough, wherein the channel defines a retention element at a proximal end.
 29. A driver, comprising: a body having a first half and a second half, the first half defining a first hole at a proximal end and the second half defining a second hole at a distal end; a drive coupling positioned between the first half and the second half of the body, wherein a portion of the drive coupling extends through the first hole and is configured to be coupled to a driver; a drive bit positioned between the first half and the second half of the body, wherein a portion of the drive bit extends through the second hole; and a first gear having a first gear ratio and a second gear having a second gear ratio, wherein the first gear is positioned adjacent to the drive coupling and the second gear is positioned adjacent to the drive bit configured to transfer rotation of the drive coupling to the drive bit.
 30. The driver of claim 29, wherein the drive coupling comprises a drive gear coupled to a first end, wherein a drive gear ratio is equal to the first gear ratio.
 31. The driver of claim 29, wherein the drive bit comprises a bit gear coupled to a first end, wherein a bit gear ratio is equal to the second gear ratio.
 32. The driver of claim 31, wherein at least one of the first half or the second half of the body define a sanitization opening configured to provide inlet and outlet of a fluid during a sanitizing process.
 33. The driver of claim 30, wherein the first gear is positioned in a linear abutting relationship with the drive coupling and the drive bit. 